| SURGICAL SITE INFECTIONS | PREOPERATIVE CARE | POST OPERATIVE CARE | WOUND MANAGEMENT | PATIENT/ FAMILY EDUCATION |
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HEALTHCARE-ASSOCIATED INFECTION.
This is seen as PREVENTABLE harm to our patient. CDC states SSIs are a significant cause of morbidity and mortality, leading cause for readmissions. These infections have been reported to comprise 20% to 31% of all HAIs among hospitalized patients. SSI is the most costly HAI
What term is used by the Centers for Medicare and Medicaid Services (CMS) to describe/ categorize an surgical site infection (SSI)?
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NO!
if the patient refuses/ cannot take off jewelry, there is a form that surgery will have them sign.
Can the patient take their belongings to surgery? (jewelry, cell phone, piercings, purse)
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The patient AND family/care giver. This also includes signs and symptoms of infections; Local Redness
Local Warmth localized Swelling pain and/ or tenderness Fever drainage
Who is to receive discharge instructions regarding post-operative considerations?
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YES!
Never change a surgical dressing unless you have an order! If you don't have an order- get one!
Should you expect to see a physician’s order for dressing changes.
True or False? |
Ask them, did you wash your hands?
Make sure that your healthcare providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub. If you do not see your providers clean their hands, please ask them to do so. • Family and friends who visit you should not touch the surgical wound or dressings. • Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands.
What should a patient do/ ask when a health care provider is going to touch the surgical area?
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Staphylococcus & Streptococcus
The most common bacteria Staphylococcus, Streptococcus, and Pseudomonas cause SSI
What are the two most common microorganisms that live on our skin?
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CHG BATHING
CHG baths prevent HAIs. The topical agent has excellent antimicrobial activity against gram-positive organisms, rapid onset and prolonged residual effect. And, this needs to be continued post operatively.
What specific action is the patient instructed to do the night before the surgery as well as the morning of surgery?
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everyone is involved and warming the patient needs to start even before surgery. ER and In-patient can keep the patient normothermic.
hypothermia causes tissue hypoxia, vasoconstriction, and does increase chances of SSI
How does the patient's temperature affect wound healing?
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The surgeon!
If a very recent surgical patient presents to the ER with complaints regarding his/ her surgical incision, who needs to be called?
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NO! We need to educate that the patient only take a shower and to use the rest of the CHG soap.
Can a patient with a surgical wound take a bath?
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An antibiotic
Administration of the appropriate antibiotic should occur so that the peak efficacy of the medication is in the patient's tissues and bloodstream immediately before incision
What medication should all surgical patients receive within one hour of incision?
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CLIPPING, not shaving
we clip for surgical field visualization chloraprep, the surgical prep, stays "wet" on hair for up to an hour. hair can be a source for infection
If the surgical site has hair, what must happen?
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SHOULDER PAIN
What type of pain may a patient experience after having a laparoscopic procedure where gas is put into the abdomen?
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The suture or staple line. when caring for a surgical incision, start at the incision and work away. NEVER return to surgical incision site with the same washcloth.
When you are cleaning the incisional area, what area do you start with?
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STOP SMOKING, or at least minimize usage while wound is healing
Study revealed active smokers developed SSI at a rate of 12% compared to never-smokers/ recent abstain from smoking (2%)
If the patient is a smoker, what education can we give to help prevent an SSI?
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30 DAYS
Surgery with an implant is 90 days
What is the length of time after a surgery, without an implant, that once reported is deemed an HAI/ SSI by CMS?
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The Preoperative Checklist.
this can be wrenched in using the search tool found in the upper right corner under flowsheets. helpful guide to ensure you acknowledge last solid, liquid. Identify consent complete, is an addendum needed for the DNR? labs, tests, blood band, any prep? Also, consent. does the patient have a DNR? if so, needs an addendum
What needs to be completed in Epic before the patient goes to surgery?
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ASEPTIC TECHNIQUE
What type of technique should the nurse follow when changing a dressing?
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Wound Care RN/ Team
St Vincents Diane Stanfa St Charles Heather Carpenter St Annes Rhonda Revels Rural: For DEFIANCE, call the clinic, three RNs Emily Koch, Ashley Krinke, and Kay Martin For TIFFIN: place consult. 3 Drs and RN cover WILLARD: inform hospitalist or utilize Tiffin wound nurse
Who can you call, BESIDES THE SURGEON, if you have any questions or concerns regarding the surgical incision site?
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Wash their hands! Do they know how to properly wash their hands? Include this in the AVS
What is one the most effective actions a patient can do to help prevent a SSI?
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1. Superficial: skin and subcutaneous tissue of the incision
2. Deep Incisional: deep soft tissues of the incision 3. Organ space: involves any part of the body deeper than the fascial/muscle layers that is opened or manipulated during the operative procedure
The CDC uses three categories for an SSI, do you know what these three categories are?
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Pre-operatively, ideally in surgeon's office but continue throughout hospital stay, also to be included with discharge instructions. Includes how to care for wound as well as S & S of infection
When should incisional care education be provided to the patient?
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to maintain normal serum glucose levels.
Hyperglycemia is significantly associated with an increased risk for SSIs. Blood glucose levels rise during and after surgery due to surgical stress. Hyperglycemia impairs numerous host defense mechanisms and the risk of SSI increases. It is essential to control serum blood glucose levels for all surgical patients, including patients without diabetes. Well-controlled blood glucose levels have a significant benefit in reducing the risk of SSI development.
If you have a patient who is diabetic, what important education needs to be provided?
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Nutrition plays a critical role in the wound healing process. Deficiencies in a patient’s nutritional status can prolong and interfere with wound healing.
How can the nutritional status of a patient affect wound healing?
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NEVER!
Steri-strips should be kept dry for the first 24 hours, and will fall off on their own, typically 7 to 10 days
When should the patient remove steri strips, if there are steri strips over the incision?
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